Medical Billing Coding - CMS 1500 FORM FIELD 24 E, cpt, codes
medical billing and coding forum

BC Advantage Magazine


General Medical Coding Forum

New Topic  |  Search

Thread Topic: CMS 1500 FORM FIELD 24 E
Topic Originator: ocean-eyes
Post Date March 29, 2011 @ 2:21 AM

March 29, 2011 @ 2:21 AM Reply  |  Email Friend   |  |Print  |  Top

Hello i am medical assistant student in desperate need of help with understanding with a Field 24 E part of CMS FORM.

Am having so much trouble am ready to cry so someone please help me out my instructor is doing lousy job of explaining this or says we have to do it our selfs.

Here is a scenario : Boy fell playing and
landed on his elbow was rushed to hospital ER Doctor did expanded focused exam and history did x rays 2 views and diagnosed him with contusion to the elbow decision was of low complexity .

So if the ICD-9 -CM CODE for this was 923.11
and CPT Code for examination and history in ER was 99282. and for X Rays was 73070.
what am i suppose to put in field 24 E and why i don"t get this at all

( 24e. If the medical procedure for line 1 is a result of diagnosis code 1, then enter a 1 in this field. If it
is a result of diagnosis code 1 & 2, then enter 1,2 in the field. If it is a result of diagnosis code 2,
then enter 2 in this field. )

Cause i have to do it twice actually on this particular scenario for both codes.

CPT CODE Field 24 E ?

Once again Please help me correct me if and where am wrong but most of all help me understand this .

steve verno
March 29, 2011 @ 7:45 AM Reply  |  Email Friend   |  |Print  |  Top

If your instructor cant or isnt helping you, you have an obligation to go to the class administrators and tell them.  You are paying them to provide you with the proper instruction and your instructor is paid to teach you properly.  If you dont, you will fail when you complete your training and you wont be able to get the job you paid to be trained to do.  Once you finish your training, there is a real life pass or fail.  Pass means you get the job and you do it with no mistakes and your provider is paid correctly on his/her claims.  Fail means your claims are denied, the insurance company audits your claims, demands the return of any payments they made, you get fired and never hired again and you might be sued, go to jail or be sanctioned.  

Block 24E is the 'DIAGNOSIS POINTER"  On the claim form, you put the diagnosis or diagnoses in block 21.  Block 24E is where you select the diagnosis that supports the procedure you put in block 24D.  For example, a patient comes to the ER with chest pain (786.50).  The doctor does an EKG interp (93042).  You put 786.50 in 21(1).  In Block 24D, line 1, you put 99283 (ED E/M).  To support the ED visit which is why the patient came to the doctor, in this case, chest pain, you put a 1 in 24D because the chest pain supports the ED E/M.  

In Block 24d, line 2, you put 93042 for the EKG interp.  To support the EKG, and the reason why the doctor did the EKG is because the patient had chest pain, so 786.50 also supports the EKG interp, so in block 24D line 2, you also put a 1.  

To make things easy, you are putting together a puzzle of the visit.  The two pieces are easy, what the doctor did and what was wrong with the patient to support what the doctor did.  The patient came to the ER with chest pain.  In emergency medicine, you bill the ER visit and why the patient came to the ER that supports the level of the ER visit.  

Lets go one step further.  lets say the patient came in with chest pain and they fell, causing a cut on the head.  You have 2 diagnoses, chest pain and open wound.  The doctor didnt suture the wound, just put a bandage on it.  So, the ED visit code may still be 99283.  But, now you have 2 diagnoses.  Chest pain and open wound to the head.  You put the chest pain diagnosis in block 1 of Field 21 and you put open head wound diagnosis in block 2 of field 21.  You have one CPT code, 99283, and you have two diagnoses to support the 99283.  So, in 24D of line 1, you put 99283.  In 24D, you put 1 2.  You are linking both diagnoses in Field 21 to 99283.  In essence, you are telling everyone that chest pain and an open head wound are why the patient came to the emergency room and they both support 99283.  

Good luck and much success.

Steve Verno
Certified Medical Billing Specialist
Certified Emergency Medicine Coding Specialist
Certified Multispecialty Coding Specialist
Certified Medical Billing Specialist Instructor
Professor of Coding and Billing, Everest University (Medical Leave)
Director of Reimbursement, Emergency Medicine Specialists of Florida

steve verno
March 29, 2011 @ 7:48 AM Reply  |  Email Friend   |  |Print  |  Top

Im sorry, my cat kept jumping on my laptop wanting attention.

When I said 24D for the diagnosis, it should be 24E (diagnosis pointer)

24D is the CPT code (9928X)
24E is the number that refers to the diagnosis in field 21.

steve verno
March 29, 2011 @ 8:45 AM Reply  |  Email Friend   |  |Print  |  Top

I hate doing repeat postings but I have to.  i work at home for 14 emergency care practices, 120 doctors.  I also help abandoned cats.  I just got 3 who were abused by some neighbor kids, and one wants constant attention, so Sammi jumps on my lap and wants to sit on my laptop.  

lets go over this one more time.


57 year old man goes to the emergency room with chest pain and no other problems. The doctor orders an EKG to see if the patient is having a heart attack.  He interprets the EKG and no heart attack, lab results ordered show no heart attack.  all the patient has is chest pain.
The records document a 99283 ER visit.  The chest pain is 786.50.

Now you need to fill out the claim form.  You have the procedure codes which is what was done to the patient and you have the diagnosis code which is what was wrong with the patient and what brought the patient to the emergency room.  You have the er visit, 99283 and a separate procedure that was done in addition to the ER visit, this would be 93042, the EKG interp and report.  Per NCCI and Page 4 of CPT, 93042 is not bundled with 99283 and tests such as 93042 are not included with an E/M.  so, you would report both 99283 and 93042.  You would use modifier 25 with 99283 to report that the ER visit is significant and separate from the EKG interp.  

On the cms 1500 form, you put the 786.50 in field 21, block 1.  and you need to fill out 2 lines of Field 24, blocks a through J.
CPT 99283 goes on Field 24D of line 1.  Modifier 25 is placed in Field 24D of line 1.  To support the 99283, you link chest pain 786.50 to 99283.  In Field 24E, you put a number 1.
Now you report the EKG interp, 93042.  On Line 2 of 24, in field 24D, you put 93042 and now you have to have a diagnosis to support the EKG.  So, your chest pain also supports the EKG because it is why the doctor did the EKG.  To link the chest pain to the EKG, you also put a 1 in block 24E of line 2.  

Just remember, you have CPT codes.  To support why the CPT code was done, you must have a diagnosis that relates to the CPT.  Chest pain supports an EKG.  If the patient had an open wound to the head, it wouldnt support an EKG.  To make it easy to understand, you take your car for a tune-up.  putting new tires on your car doesnt support an engine tune-up.  New spark plugs supports an engine tuneup.  Billing is using logic.  Lets say a patient cuts their hand.  Would reporting applying a cast to the leg, be supported by a minor open wound to the hand?  No.  Would a fracture of the fibula support a cast to the leg?  yes.  So, the diagnosis we link medically and logically links to what was done.  

Now, lets go one step further.  The patient has chest pain and fell, causing an abrasion to the head.  You will have at 2 diagnoses, chest pain, and abrasion.  In fied 21, you put the chest pain and abrasion diagnosis. Chest pain, being the more serious is in Block 1 of field 21.  Abrasion which is the least serious goes in Block 2 of field 21.  You have the EKG and ER visit.  The ER visit is supported by the chest pain and abrasion diagnoses.   Line 1 is where you report the 99283.  You report modifier 25 to support the significant and separate ER code bedause the ER visit is separate from the EKG that was done.  The patient didnt come to the emergency room specifically for an EKG alone.  YOu have the chest pain AND abrasion to support the 99283.  So field 24D shows 99283.  Field 24E links both EKG and abrasion to the 99283.  you have chest pain in block 1, abrasion in block 2, so you put 1 and 2 in block 24E.  You have the EKG (93042) on line 2, field 24D.  The abrasion doesnt support why the EKG was done, so you wouldnt report the abrasion diagnosis for the EKG.  Block 24D on line 2 shows 93042.  Block 24E of line 2, shows 786.50, the chest pain diagnosis.  

There is no need for line 3 because you have no more procedures to report.  

Field 21, your disgnosis field has space for 4 diagnoses.

I was called to a local doctor who is being audited by Federal Marshals for fraud.  I looked at a claim where he put 20 diagnoses in block 21.  The record documented 20 diagnoses.  I looked and that particular visit only justified one diagnoses.  He said his coder told him to put everything wrong with the patient down as a diagnosis.  The patient came in for a followup visit due to stubbing his toe on the coffee table.  The doctor diagnosed the patient with Aids, a toe fracture, sprain and strain toe.  I asked if he did an xray, he said no, but his coder told him to disgnose suspected or possible conditions.  When speaking with the coder, she said, "this is the way we always do it."  I commented they wont anymore after the marshals leave.  I also showed her the coding guidelines in the ICD-9 manual which states you dont code suspected, possible diagnoses and you code only the diagnoses for that visit, not all past visits.  All his visits were level 5 visits which triggered the audits.  Long story short, the doctor has closed his practice, has been sanctioned and ordered to pay back hundreds of thousands of dollars.  The coder and biller were fired and will most likely not find work in our area again.  Dont get into the this is the way we always do it attitude, follow your training and the coding guidelines in the manuals.  Again, if your instructor cant answer your questions, bring this to the attention of the teaching institution.  You are paying for a service.  This will be my only response because I dont help students.  Why?  your teaching institution isnt paying me to teach you.  Good luck in your future.

July 12, 2011 @ 1:23 AM Reply  |  Email Friend   |  |Print  |  Top

In the same position as the person you helped before. Here's the question:
For a medicaid case what two blocks on the CMS-1500 (08-05) form need to be completed for emergency services?

The story line is a lady has lab verified ruptured appendix, immediate surgery is recommended. No prior auth was gotten.

Please help with the two blocks for emergency services thing. No one explains this, just expected to figure it out. Thank you if you can help!

Copyright © 2008 Billing-Coding Inc